住院患儿静脉输液工具使用及留置现况的调查研究

Investigation on the application and retention of intravenous infusion tools in hospitalized children

目的调查住院患儿静脉输液时不同工具的使用情况以及静脉导管留置期间存在的问题,从而为临床提供指导。方法采用方便抽样的方法,于2018年7月24—31日,选择北京儿童医院医联体范围内49家医院的住院患儿静脉输液治疗情况进行调查。应用自行设计的儿童静脉输液情况横断面调查表及拍摄静脉输液工具的照片进行资料收集。采用SPSS 17.0软件进行统计学分析。结果调查期间49家医院共有住院患儿18316例,输液患儿14421例,输液比例为78.73%。静脉导管的应用情况为外周静脉短导管(留置针)占87.94%;静脉导管的连接以肝素帽连接为主,占64.23%,6398例(44.37%)患儿应用的输液工具为聚氯乙烯(PVC)材质且含邻苯二甲酸二(2-乙基)己酯(DEHP);在敷料选择方面以无菌透明敷料固定为主。导管留置期间存在问题主要是导管或输液接头内有回血发生率、导管夹夹闭位置不正确或未夹闭,导管脱出,且留置针存在的问题多于中心静脉导管,其中管道内有陈旧回血、输液接头内有回血发生率,外周留置针和中心导管比较差异有统计学意义(P<0.05)。结论住院患儿静脉输液率较高,虽然静脉输液工具种类繁多,但对于儿童患者输液工具的选择以外周静脉留置针穿刺和肝素帽连接为主,导管维护方面尚存在不足。

Objective To investigate the use of different tools of intravenous infusion and the issues associated with intravenous catheter indwelling in hospitalized children and to provide reference for clinical practices.Methods Using the convenient sampling method,from July 24th to 31st,2018,the intravenous infusion treatment of children inpatients in 49 hospitals within the Beijing Children's Hospital Medical Association was selected for investigation.A self-designed Cross-sectional Questionnaire for Children's Intravenous Infusion and a photo of an intravenous infusion tool were used for data collection.Statistical analysis was performed using SPSS 17.0 software.Results During the data collection period,there were 18316 hospitalized children in the 49 hospitals,among which there were 14421 cases of infusions,with the infusions rate of 78.73%.The application rate of indwelling needle was 87.94%.The connector of venous catheter was mainly heparin cap connection(64.23%).The infusion tools used in 6398 cases(44.37%)were made by PVC and containing 2-ethyl hexyl phthalate(DEHP).Aseptic transparent dressing was the main dressing choice.During catheter indwelling,there were some problems such as back-blood in the pipeline or infusion joint,incorrect clamping position of small clips,unclamping,and tube detachment.Indwelling needles had more problems than central venous catheters,including old blood returning in the tube and blood returning in the infusion connector.The difference between the peripheral indwelling needle and the central catheter was statistically significant(P<0.05).Conclusions The rate of intravenous infusion in hospitalized children is relatively high.Although there are various types of intravenous infusion tools,the choice of infusion tools for children was mainly indwelling needle and heparin cap connection,and there were still room for improvement in catheter maintenance.